Healthcare Provider Details

I. General information

NPI: 1578053047
Provider Name (Legal Business Name): 702 HOME HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S VALLEY VIEW BLVD STE 4 RM 3
LAS VEGAS NV
89102-0116
US

IV. Provider business mailing address

8534 BENIDORM AVE
LAS VEGAS NV
89178-4806
US

V. Phone/Fax

Practice location:
  • Phone: 702-354-5478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8595-HHA-0
License Number StateNV

VIII. Authorized Official

Name: MICHELLE LIM-BARGO
Title or Position: SECRETARY
Credential:
Phone: 702-354-5478